Pediatric researchers have achieved some of medicine’s biggest wins, but the federal agency supporting them has become outdated and unable to keep pace with the worsening state of children’s health.

So concludes a JAMA Pediatrics Viewpoint from LDI Senior Fellow Christopher B. Forrest and colleagues charged by the National Academies of Sciences, Engineering, and Medicine with evaluating the state of pediatric research.

Forrest led a team last year that showed U.S. children die sooner and are sicker now than 20 years ago. A stunning range of chronic diseases afflict more children, ranging from eating disorders, obesity, and sleep apnea to anxiety, loneliness, and depression.

In their commentary, Forrest and colleagues Shafali S. Jeste of UCLA and Seema K. Shah of Northwestern University cite the National Institutes of Health (NIH)’s record of successes but note many areas for improvement. Pediatric studies are harder, slower, and more costly to run than trials for adults, but federal grants fail to recognize this.

Indeed, many NIH studies exclude children despite policies meant to include them.

There’s no disagreement about why this matters. Improving children’s health leads to healthier adults, lower long-term health care costs, and stronger public health for decades to come.

“The urgency of acting on these recommendations cannot be overstated,” the authors write. “As child health continues to deteriorate across multiple domains, bold steps are needed to protect children through research rather than from it.”

Here’s a listicle of the commentary’s key points.

1. NIH-Funded Research Helped Make Deadly Childhood Diseases Survivable

Its breakthroughs transformed cystic fibrosis and sickle cell disease, while vaccines for rotavirus and COVID-19 saved children’s lives.

2. America’s Child Health Is Worsening

U.S. children now face rising chronic illness rates and higher mortality than children in other wealthy nations, signaling a growing child health crisis across many areas.

3. Pediatric Research Funding Has Grown — but Momentum Has Stalled

NIH pediatric research funding rose from $3.6 billion in 2015 to $6.2 billion in 2024, but inflation-adjusted growth has been largely flat since 2020.

4. Every NIH Institute Funds Child Health Research — Some More Than Others

The Eunice Kennedy Shriver National Institute of Child Health and Human Development devoted 60% of its budget to pediatric research in 2024, while cancer, mental health, heart, and infectious disease institutes also made major investments. However, other NIH institutes offer no measurable goals to improve child health.

5. Major Studies Routinely Exclude Children

Despite NIH policies supporting inclusion, ethical confusion and “adults-first” research practices delay pediatric participation for years, stunting evidence-based care for children.

6. Pediatric Studies Are More Costly and Harder to Run

Recruiting children into research often requires more hospitals, longer timelines, and more consent hurdles, making standard NIH grants ill-suited to pediatric science.

7. A Small NIH Collaboration Could Become a Major Force in Child Health Research

The NIH Pediatric Research Consortium, known as N-PeRC, helps coordinate pediatric research across institutes but does so without dedicated funding or staffing.

8. Researchers Need Larger Grants and Longer Timelines for Pediatric Studies

The report recommends larger budgets, supplemental funding for hard-to-reach families, and longer grant periods to spur research with children.

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The Viewpoint, “NIH-Funded Pediatric Research,” was published on April 25, 2026 in JAMA Pediatrics. Authors include Christopher B. Forrest, Shafali S. Jeste, and Seema K. Shah.

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